Healthcare Provider Details

I. General information

NPI: 1013656727
Provider Name (Legal Business Name): MELISSA APRIL PELLETIER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 WASHINGTON ST
AMELIA COURT HOUSE VA
23002-4897
US

IV. Provider business mailing address

PO BOX 293
AMELIA COURT HOUSE VA
23002-0293
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-5057
  • Fax: 804-561-2294
Mailing address:
  • Phone: 804-561-5057
  • Fax: 804-561-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701011525
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: